Mediastinal compressive nodular goiter – A very rare cause of obstructive acute respiratory failure.

Abstract

Introduction: In neglected cases, thyroid goiters may reach such extreme dimensions that they cause respiratory, swallowing, or vascular compromise. Large goiters have a tendency to extend retrosternally and, in ectopic cases, may develop entirely within the mediastinum. When no additional space is available within the thoracic cavity to accommodate further growth, they can present as acute respiratory failure.

Case presentation: We present the case of a 72-year-old female patient with a known history of thyroid goiter who was admitted to the emergency department with acute respiratory failure. A thoracic CT scan revealed an approximately 10 cm mediastinal mass causing near-complete tracheal obstruction. As the patient’s respiratory function deteriorated, an emergency surgical intervention was performed by a multidisciplinary team consisting of an anesthesiologist, endocrine surgeon, thoracic surgeon, and cardiac surgeon. A sternotomy and total thyroidectomy were carried out. The postoperative course was uneventful, and the patient was discharged from the hospital on postoperative day 10 in good general condition, without subjective complaints.

Conclusions: In extremely rare cases, thyroid pathology may lead to acute respiratory failure, requiring immediate surgical intervention. The case is further complicated and rendered exceptional by the presence of a completely intramediastinal thyroid gland, necessitating a multidisciplinary approach.